This unannounced inspection took place on 10 November 2016. We last inspected the service in August 2015 when it was rated overall as ‘good’.

Briarwood is set in its own grounds within a residential area of Blaydon. It compromises of two separate units that provide nursing care to people with mental health issues. ‘Meadows’ is a 12 bedded unit that cares for people who live with dementia and may exhibit behaviour that challenges. ‘Mill View’, is an all-female unit and provides support for 12 people to enable them to live independently within the local community.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Care plans were subject to regular review to ensure they met people’s changing needs. They were easy to read, based on assessment and reflected the needs of people. Risk assessments were carried out and plans were put in place to reduce risks to people’ safety and welfare

Where people were not able to make important decisions about their lives the principles of the Mental Capacity Act 2005 were followed to protect their rights. Staff were aware of how to identify and report abuse. There were also policies in place that outlined what to do if staff had concerns about the practice of a colleague.

Staff were trained to an appropriate standard and received regular supervision and appraisal. As part of their recruitment process the service carried out background checks on new staff. The service was not using a dependency tool to help them set staffing levels, we made a recommendation about this.

The service managed medicines appropriately. They were correctly stored, monitored and administered in accordance with the prescription. People were supported to maintain their health and to access health services if needed. People who required support with eating and drinking received it and had their nutrition and hydration support needs regularly assessed.

Staff had developed good relationships with people and communicated in a warm and friendly manner. They demonstrated good communication skills in relation to supporting people who lived with mental health difficulties. They were aware of how to treat people with dignity and respect. Policies were in place that outlined acceptable standards in this area.

There was a complaints procedure in place that outlined how to make a complaint and how long it would take to deal with. People were aware of how to raise a complaint and who to speak to about any concerns they had. The registered manager understood the importance of acknowledging and improving areas of poor practice identified in complaints.

The home was well led by a registered manager who had clear ideas about the purpose of the service. A quality assurance system was in place that was utilised to improve the service.

People were asked for their consent before receiving care and treatment. One person commented, "Staff ask me if I want a bath." Another person commented, "I have a choice. If I say no staff accept that."

People had their needs assessed and the assessment was used to develop personalised nursing support plans. One person commented, “It is very good here. I have been on the minibus to the coast and I go to the shops with the staff.”

We found people usually received their medication in a timely manner. Medication was only administered by trained and competent staff.

People who used the service, family members and staff told us there were enough staff to meet people's needs. One person commented, “I can go to the staff anytime and get help straightaway”, and, “Lovely staff, all very nice.” Another person commented, “All good people who work here.” Family members said, “Staff are lovely, very understanding”, and, “There is always someone to talk to, they definitely look after her needs.”

People knew how to complain if they had any concerns about their care or treatment. One person commented, “I am pretty happy with the care.” Another person commented, “I have no complaints at all, if I did I would speak to the staff. The staff are nice.” One family member said, “Spot on, no problems.”

Some of the people who lived at the home had complex needs which meant they were not able to tell us their experiences. We used a number of different methods to help us understand their experiences, which included speaking to relatives and observation. Throughout the observation we saw that staff treated people with respect and courtesy.

People who could share their experiences told us they were supported to maintain their independent daily living skills. One person told us, "I help lay the tables before each meal. It helps me stay involved."

People and their relatives were very positive about the standard of care. One relative said, "My wife used to get regular infections, but since coming here she has had only one. It's down to the care."

We reviewed four care records and saw that people's preferences and care needs had been well documented. We spoke with four members of staff. Staff were knowledgeable about the care needs of the people who used the service and what they should do to support them.

Staff received appropriate professional development and there was an effective system in place to make sure staff training was up to date so that staff could care for people safely and to an appropriate standard.

We found that the provider had made suitable arrangements to protect vulnerable people from the risk of abuse and that there was an effective system in place to monitor and assess the quality of the service.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Briarwood provides nursing care for up to 29 people with mental health needs. At the time of this inspection there were 24 people living at Briarwood. The bottom floor called ‘Meadows’ provides accommodation for individuals living with dementia and the top floor called ‘Millview’ provides accommodation for individuals diagnosed with mental health conditions. Extensive redecoration work was being carried out to Meadows which meant that some areas were not available for people to use.

This was an unannounced inspection. The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We last inspected Briarwood in October 2013. At that inspection we found the service was meeting all the essential standards that we inspected.

People and family members told us they felt safe living at Briarwood. People said they felt settled and found it easy to talk with staff. We observed staff supporting people to maintain their safety. For example, we saw that staff assisted one person who used a wheelchair to negotiate around furniture.

On admission to Briarwood people were routinely assessed against a range of potential risks, such as poor nutrition, falls, skin damage and mobility. Where other risks had been identified assessments had been carried out to ensure people received appropriate care.

Staff had a good understanding of how to keep people safe and knew how to respond to safeguarding concerns and behaviours that challenged the service.

Mental Capacity Assessments had been completed in line with the requirements of the Mental Capacity Act 2005 (MCA). We also found the provider acted in accordance with the requirements of the Deprivation of Liberty Safeguards (DoLS). Where required DoLS applications had been made to the local authority.

The provider had systems in place to ensure people received their medication from trained and competent staff. Records showed that people received their medication when it was due. Some people told us they felt the evening medication round was too late and this affected when they could go to bed.

We found that there were enough trained staff to meet people’s needs. Staff we spoke with said they were well supported by the management team and had opportunities to have one to one time with their manager. Staff had completed specialist training to help them support people’s individual needs, such as catheter training, dysphagia (swallowing difficulties), wound management, stroke care and phlebotomy (taking blood).

The provider had systems in place to identify people who were at risk of poor nutrition. We saw that people were actively involved in preparing their own meals. Where people required assistance with eating and drinking they received this support uninterrupted.

People were supported to meet their healthcare needs and had regular access to a range of healthcare professionals, such as the GP, psychologist and the dietitian. Staff supported people to access health appointments when required.

Family members told us that their relative was well cared for. We observed care being delivered and found that people received their care from friendly and respectful staff. People received regular interaction from staff throughout our inspection. People were supported to maintain their independence and their interests. They also had access to a range of activities both inside Briarwood and in the community.

People were asked to give their consent before receiving any care. Care plans were evaluated regularly to ensure they were up to date.

People and family members had opportunities to give their views about the service and we found these views were acted on. We saw the views of family members were largely positive. We found the provider had in place a complaints policy and people told us they knew how to make a complaint.

The provider undertook a range of checks and audits as part of its quality assurance programme to assess the quality of care provided. This included both internal and external checks on the quality of care delivered. The findings from audits were used to make improvements to the service. Records showed that staff regularly logged any incidents and accidents, which included the specific details of the incident or accident and the action taken to deal with the situation. The on-line system used to record incidents had in-built senior management checks to ensure that appropriate action was taken following an incident. Information was analysed to look for trends and patterns and to identify learning to improve the quality of the care provided.